They approve but they don’t act: promoting sustainable minority behavior with (conflicting) social norm appeals
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PROVIDER: S-EPMC11233761 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:INTRODUCTION:The longitudinal integrated clerkship is a model of clinical medical education that is increasingly employed by medical schools around the world. These guidelines are a result of a narrative review of the literature which considered the question of how to maximize the sustainability of a new longitudinal integrated clerkship program. METHOD:All four authors have practical experience of establishing longitudinal integrated clerkship programs. Each author individually constructed their Do's, Don'ts and Don't Knows and the literature that underpinned them. The lists were compiled and revised in discussion and a final set of guidelines was agreed. A statement of the strength of the evidence is included for each guideline. RESULTS:The final set of 18 Do's, Don'ts and Don't Knows is presented with an appraisal of the evidence for each one. CONCLUSION:Implementing a longitudinal integrated clerkship is a complex process requiring the involvement of a wide group of stakeholders in both hospitals and communities. The complexity of the change management processes requires careful and sustained attention, with a particular focus on the outcomes of the programs for students and the communities in which they learn. Effective and consistent leadership and adequate resourcing are important. There is a need to select teaching sites carefully, involve students and faculty in allocation of students to sites and support students and faculty though the implementation phase and beyond. Work is needed to address the Don't Knows, in particular the question of how cost-effectiveness is best measured.
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Project description:Many social challenges stem from individuals' tendency to prefer immediately rewarding but suboptimal behaviors ("Give-Up" options) over more costly endeavors that yield much better outcomes in the long run ("Try" options). For example, many people forgo the long-term benefits of formal education, healthy diets, learning new technologies, and even finding true love. This paper examines various incentivization programs that combine external rewards and punishments to discourage such counterproductive behaviors, which often result in only temporary behavioral change. Our findings suggest that some interventions' limited impact may be due to their focus on only shifting behaviors from "Give-Up" (e.g., dropping out of college, avoiding the gym) to "Try" (e.g., attending college, exercising regularly), without promoting sufficient exploration of these "Try" options. Yet exploration of the long-term benefits of "Trying" may be crucial to increase the chances of long-term learning and commitment. Using a simplified abstraction of this dilemma, our results show a high tendency to choose "Give-Up" options prior to intervention. Examination of four different incentivization strategies suggests that only rewarding exploration of new "Try" options is a straightforward strategy to increase exploration and optimal choice. Punishing both the selection of "Give-Up" options and the choice to exploit suboptimal "Try" options produced similar results. Other common guidance strategies were less effective, as these strategies simply tended to replace one suboptimal behavior with another. Surprisingly, punishments seemed to be a relatively more successful incentive than rewards. We discuss how these insights can help guide policy aiming to improve long-term outcomes through incentivization.
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Project description:BackgroundCompetitive hypothesis testing may explain differences in predictive power across multiple health behavior theories.PurposeWe tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior.MethodsWe analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n = 704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ (2) difference testing.ResultsBarriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers.ConclusionsOur results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography.
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